Health Communication, 25: 22–31, 2010 Copyright © Taylor & Francis Group, LLC ISSN: 1041-0236 print / 1532-7027 online DOI: 10.1080/10410230903473508 HHTH Informed Consent to Treatment’s Sociohistorical Discourse of Traditionalism: A Structurational Analysis of Radiology Residents’ Accounts Informed Consent to Treatment's Discourse of Traditionalism James Olumide Olufowote Communication Department Boston College Informed consent to treatment (IC) is designed to protect patient autonomy and control through disclosures and shared decisions. However, many malpractice claims suggest patients perceive problems with its handling (e.g., information withholding). Moreover, previous stud- ies of IC lack the nuance of discursive perspectives, theoretical grounding, and recognition of IC’s sociohistorical context. Drawing on a structurational perspective, which conceives of IC as constituted by contradictory sociohistorical structures (discourse formations) representing different groups’ interests in controlling IC, this study examines how the structure representing physicians’ interests is (re)produced in practice. Focus group accounts reveal how radiologists— drawing upon interpretive schemes of patients as fearful, ignorant, and easily controlled— discursively and skillfully manipulate IC language and information in engineering patients’ decisions. Studies of medical malpractice claims reveal that patients perceive serious problems with issues relevant to informed consent to treatment (IC) (e.g., Berlin & Berlin, 1995; Gittler & Goldstein, 1996; Levine, Brandt, & Plumeri, 1995). IC, designed to honor patient autonomy and control, involves physician disclosures such as risks, physician rec- ommendation of a plan and alternatives, and patient choice and consent (Beauchamp & Childress, 1994, pp. 145–146). IC to treatment and IC to research are distinguishable. IC to treatment is concerned with the everyday diagnosing or treating of individuals, whereas research is designed to gen- erate knowledge (Lidz, 2006; National Commission for the Protection of Human Subjects of Biomedical and Behav- ioral Research, 1978). IC involves several actors and has important implications for each one. IC is important to patients because it improves outcomes such as treatment efficacy, coping, and satisfaction (e.g., Clark, 2007; Garrud, Wood, & Stainsby, 2001; Mills & Krantz, 1979). Families value it because it facilitates their involvement, especially when patients are minors or incompetent. For providers, IC can facilitate shared decision making as well as protection from litigation. Research on IC can contribute to these outcomes as well as improve our understanding of the process. Previous studies of IC relied on surveys or observational coding to assess the average degree to which practitioners expressed or withheld information across patients (e.g., Braddock, Fihn, Levinson, Jonsen, & Pearlman, 1997; Levine et al., 1995; Sulmasy, Lehman, Levine, & Faden, 1994). These efforts lacked interpretive and discursive per- spectives, which emphasize the dynamic nature of the medi- cal encounter, the generative role of participants’ meanings, and the discursive means through which IC unfolds. Such perspectives offer a more nuanced picture of the process and a better understanding of why IC unfolds as it does. Also, previous studies were rarely grounded in theory. This is unfortunate, as theory can situate the idea of IC in broader intellectual and scholarly discourses, and can better connect IC investigations with each other by offering a shared plat- form for understanding, examining, and critiquing practice. This study employs a structuration perspective (Olufowote, 2008, 2009). In developing this perspective, Olufowote drew on analyses of IC law and literature in reconceiving of IC as unfolding amid three contradictory sociohistorical structures (systems of meaning), which represent interests favoring Correspondence should be addressed to James Olumide Olufowote, Communication Department, Boston College, 21 Campanella Way 547, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA. E-mail: olufowot@bc.edu Downloaded By: [Boston College] At: 16:20 12 February 2011